Provider Demographics
NPI:1871618298
Name:DUNCAN, MICHAEL SHAYNE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAYNE
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 ELSIE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-5508
Mailing Address - Country:US
Mailing Address - Phone:415-920-9211
Mailing Address - Fax:
Practice Address - Street 1:224 ELSIE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5508
Practice Address - Country:US
Practice Address - Phone:415-920-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT23812OtherPHYSICAL THERAPY LICENSE